by Guest » Fri Jan 25, 2008 01:51 pm
I work in a small office that is just getting a group health insurance plan. There are 8 employees, with 12 dependants total. If we get insurance, then one of us has surgery costing $25000, does everyone end up paying for that in higher premiums next year? I want to get the gastric bypass surgery, and as I understand how group works, the group will have to absorb some of these costs? Or is that just when a group policy is self-funded?
Posted: Tue Jan 29, 2008 06:32 am Post Subject:
Well my friend, the cost of your surgery may likely to fall on all, as this is the working concept behind the group health plan. All are required to share the cost incurred by a member of the group, so that the cost gets divided and doesn't act as a burden on one.
Posted: Tue Jan 29, 2008 07:04 am Post Subject:
Hi!! What I understand form your post ( do correct me if I am wrong) that you are yet to receive the policy. If so then you may not receive coverage under the group plan for the surgery. Most of the plans don't cover the preexisting medical conditions. A particular time period has to pass by before the coverage benefits actually begin. This time period is called the preexisting condition exclusion period. The insurance company is likely to deny all the claims during this time frame. However, some policies may cover the preexisting conditions as well. Therefore, you need to find out what the policy actually covers before signing the documents.......got it!!
Posted: Tue Jan 29, 2008 07:14 am Post Subject:
Hey Small Group, if the group practices the policy of paying individual premium, then your cost may not affect the premium rates of the others. But buddy, don't depend on assumptions. Clarify all your doubts from the concern official before your induction to the group, or else, you may end up with a denied claim.
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